Poland-US collaborative study on cardiovascular epidemiology: classification agreement between US National Cholesterol Education Program and European Atherosclerosis Society hyperlipidemia guidelines in selected Polish and US populations.

Data from two epidemiological studies are used to measure the degree to which two well-known guidelines agree in measuring hyperlipidemia in population samples in the US and Poland. The epidemiological studies are the US Lipid Research Clinics Program Prevalence Study and the Pol-MONICA project in Poland and the guidelines are those adopted by the US National Cholesterol Program (USNCEP) and by the European Atherosclerosis Society (EAS). EAS guidelines were analyzed in two ways: Method 1 used triglycerides and total cholesterol only in classifying persons as hyperlipidemics or non-hyperlipidemics; Method 2 used triglycerides, total cholesterol and nine additional risk factors in the classification process. USNCEP guidelines used total cholesterol, low density lipoprotein cholesterol and the same additional nine risk factors used in EAS Method 2 in classifying hyperlipidemics. Classification differences between the two sets of guidelines were high when EAS Method 1 guidelines were compared with USNCEP guidelines. However, EAS Method 2 which included risk factors, compared favorably with USNCEP guidelines in all three populations under study.

Incidence and correlates of hypertension in the Atherosclerosis Risk in Communities (ARIC) study and the Monitoring Trends and Determinants of Cardiovascular Disease (POL-MONICA) project.

OBJECTIVE: The purpose of this research is to assess short-term blood pressure change and hypertension incidence, and identify correlates of incident hypertension in the USA and Poland. DESIGN AND METHODS: Population-based samples aged 45-64 years at enrollment from the Atherosclerosis Risk in Communities (ARIC) and the Pol-MONICA studies: including 3777 whites from Minneapolis, Minnesota, USA suburbs (urban), 3635 whites from Washington County, Maryland, USA (semi-rural) and 3109 blacks from Jackson, Mississippi, USA surveyed in 1987-1989 and 1990-1992; and 389 persons from Warsaw, Poland (urban) and 322 from Tarnobrzeg Province, Poland (semi-rural) surveyed in 1987-1988 and 1992-1993. RESULTS: Age-standardized systolic and diastolic blood pressures at both screens were 9-20 and 5-9 mmHg higher in the Polish samples than in US blacks, who had higher levels than US whites. Age-adjusted annual hypertension incidence in both Polish male cohorts (6-8%) was higher than that in US white men (4%) and approaching that of US black men (7%); rates were also higher in Polish female cohorts (8-9%) than in US black women (8%), but nearly twice those in US white women (4%). Factors independently related to hypertension incidence included age, family history, smoking, baseline blood pressures and body mass index, and increase in body mass index and alcohol consumption between screenings. After adjustment for these factors, annualized hypertension incidence was similar in US white and Polish men (2.3 and 2.7%) compared with US black men (3.4%), and in US white and Polish women (1.5 and 1.3%) compared with US black women (3.9%). CONCLUSIONS: Despite substantial differences in blood pressure levels and age-standardized hypertension incidence rates, the differences in incidence between Polish and US white men appear to be explained largely by differences in risk factors for hypertension.

Comparison of medical care and survival of hospitalized patients with acute myocardial infarction in Poland and the United States.

Few studies have evaluated between-country differences in medical care and survival after acute myocardial infarction, and none have compared the US with countries from Eastern Europe. Comparable data from the US (Atherosclerosis Risk in Communities Study [US-ARIC]) and Poland (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease project [Pol-MONICA]) were developed. From 1987 through 1993, a total of 3,694 patients were hospitalized with acute myocardial infarction events in the 2 Pol-MONICA communities and 4,801 in the 4 US-ARIC communities. Patients in the US-ARIC were 1.7 times more likely to be treated in a coronary care unit and received cardiac procedures, calcium channel blockers, and thrombolytic agents significantly more often than patients in the Pol-MONICA. The use of antiplatelet agents, nitrates, angiotensin-converting enzyme inhibitors, and beta blockade agents was similar in both countries. Case fatality (28-day) rates after hospitalized acute myocardial infarction were nearly identical (men, 7% in Pol-MONICA vs 6% in US-ARIC; women, 9% in Pol-MONICA vs 8% in US-ARIC). However, when fatal coronary heart disease events not associated with a hospitalized myocardial infarction were included, the US-ARIC rates were less than half than those seen in Pol-MONICA. Substantial differences in treatment of hospitalized acute myocardial infarction between countries did not translate into a survival advantage for patients reaching clinical attention. Differences in case severity, arising from the high out-of-hospital coronary death rate in Poland may play an important role in this finding.

Association of lipids and lipoprotein level with total mortality and mortality caused by cardiovascular and cancer diseases (Poland and United States collaborative study on cardiovascular epidemiology).

This study evaluates the relation between total serum cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol, and subsequent total, cardiovascular, and cancer mortality. These data are from 4,946 US and 5,198 Polish men and women aged 35 to 64 years at baseline with mortality follow-up over 13 years. Total cholesterol showed a U-shaped or J-shaped relation to age-adjusted total and cancer mortality across all samples, with significance only in Polish women. The multivariable adjusted relative risk for total and cancer mortality was higher in the lowest cholesterol category only in Poland and significant only for cancer. Cardiovascular mortality was positively related to cholesterol, but only in Polish men and US women was mortality significantly higher in the highest versus the lowest cholesterol category. The multivariable adjusted relative risk of cardiovascular death was greater in the highest versus the lowest cholesterol category, but this trend was significant only in the US. HDL cholesterol was inversely related to total (significant only in US men) and cardiovascular mortality (significant only in US and Polish men). A similar, but not significant, association of HDL cholesterol was found with cancer mortality. The multivariable adjusted relative risk of total mortality was inversely related to HDL cholesterol significant in both the US and Poland. The relative risk of cardiovascular mortality was significantly lower at higher HDL cholesterol levels in all samples. The relative risk of cancer mortality was highest and significant at the lowest HDL cholesterol level in the US and Poland. Elevated triglycerides were associated with increased risk of total and cardiovascular mortality, but this trend was significant only in the US. Cancer mortality was not significantly related to triglycerides. The present study indicates that in geographically and culturally diverse populations, the relation of lipids with cardiovascular mortality is similar. The relation with total and cancer mortality varies by country, gender, and lipids. This suggests that relations of total and cancer mortality with lipids or lipoproteins are weaker than associations with cardiovascular mortality.

Natural menopause and cardiovascular disease risk factors. The Poland and US Collaborative Study on Cardiovascular Disease Epidemiology.

Changes in risk factor levels associated with menopause have been reported in many studies in the United States and western Europe, where estrogen replacement therapy and surgical menopause are common. We studied risk factor associations in Polish women, for whom estrogen replacement therapy and surgical menopause are uncommon. The 357 postmenopausal women had higher total cholesterol levels (0.43 mmol/L) and low-density-lipoprotein cholesterol levels (0.36 mmol/L than did the 372 premenopausal women of similar ages. Triglycerides, high-density-lipoprotein cholesterol, body mass index, and blood pressure did not differ by menopausal status. We conclude that natural menopause is associated with higher levels of total and low-density-lipoprotein cholesterol levels. Natural menopause is not associated with large changes in other risk factors in this sample.

Poland and U.S. collaborative study on cardiovascular epidemiology hypertension in the community: prevalence, awareness, treatment, and control of hypertension in the Pol-MONICA Project and the U.S. Atherosclerosis Risk in Communities Study.

PURPOSE: The objectives of this manuscript are to assess differences in blood pressure levels and in hypertension prevalence, awareness, treatment, and control for selected rural and urban areas in the U.S. and Poland, where ischemic heart disease mortality trends are different. METHODS: Included are white persons aged 45-64 selected in Minneapolis, MN suburbs [urban] and Washington County, MD [semi-rural] from the U.S. Atherosclerosis Risk in Communities Study (ARIC) surveyed in 1987-89, and in Warsaw [urban] and Tarnobrzeg Province [semi-rural] from Poland's Pol-MONICA Project surveyed in 1987-88. Sample sizes were: U.S.--3,696 men, 3,801 women; Poland--875 men, 960 women. RESULTS: Mean blood pressures were > 15% higher for Polish samples than for the U.S. (p < 0.01). In multivariable analysis, hypertension was significantly positively related to age and body mass index (BMI) in both U.S. and Polish samples (except age in Polish men), and to heart rate in Polish samples and U.S. rural women. Smoking was significantly negatively related to hypertension in urban Polish and rural U.S. men. Hypertension awareness, treatment, and control were better in U.S. than in Polish samples. In the U.S. > 80% of subjects with hypertension (systolic blood pressure (SBP) > or = 160 mmHg or diastolic blood pressure (DBP) > or = 95 mmHg or on treatment) were controlled whereas in Polish samples < or = 17% of hypertensive men and 16% of hypertensive women were controlled. When SBP > or = 140 mmHg or DBP > or = 90 mmHg or on treatment defined hypertension, control was about 55% in U.S. samples and about 2% in Polish samples. CONCLUSIONS: Hypertension prevalence is higher and blood pressure levels are less well controlled in Polish than in U.S. samples. These striking differences can be expected to contribute to opposing trends in coronary heart disease (CHD) mortality in the two countries. Hypertension control programs in the U.S. are almost certainly responsible for much of the observed differences. There is a clear need for similar programs in Poland.

Changes over time in blood lipids and their correlates in Polish rural and urban populations: the Poland-United States Collaborative Study in cardiopulmonary disease epidemiology.

PURPOSE: The purpose of this manuscript is to examine changes in blood lipid levels and related factors between 1983 and 1987 in two selected Polish populations, to evaluate these changes and their association with other coronary heart disease (CHD) risk factors, and to examine the nutrient intake changes for consistency with observed lipid changes. METHODS: Men and women, aged 35-64 were screened from Warsaw and rural Tarnobrzeg province, Poland-the Pol-MONICA screening sites. An independent random sample of 5132 screened in 1983-84 and a second independent random sample of 2596 screened in 1987-88 were compared. A 25% cohort of the 1983-84 sample was also rescreened in 1987-88 (n = 1236) and 24-hour dietary recall information on this cohort was used to evaluate nutrient intake changes and their relationship to the lipid changes. RESULTS: For the random samples, the total cholesterol increased by 5.1 mg/dL (rural) and by 7.9 mg/dL (urban) for women; there were no significant changes among men. Low-density lipoprotein cholesterol (LDL-C) increased for all site and gender subgroups by 5.4-8.7 mg/dL. Among rural men and women, high-density lipoprotein cholesterol (HDL-C) decreased by 3.4 and 3.3 mg/dL, respectively, whereas it increased by 3.3 mg/dL among urban women and did not change among urban men. Total triglycerides (TG) increased by 9.5 mg/dL for rural men, with no significant change for rural women. For urban men and women, TG decreased by 29.5 and 21.8 mg/dL respectively. In the cohort, changes in dietary intake (decreases in energy from fat, Keys index and increases in the polyunsaturated to saturated fats ratio) were related to a decrease in TC at both sites and to a decrease or smaller increase in LDL-C for rural men. CONCLUSIONS: The observed changes were generally unfavorable, with a decrease in the proportion of persons with desirable lipid levels. At both sites nutritional changes were favorable, including a drop in total energy intake. Less pronounced were changes in percentages of total energy from fats, where the only significant decrease was for rural women; however, improvements in dietary fat composition and declines in cholesterol consumption were found. These favorable changes in diet were not strong enough or were not in effect long enough to counter the unfavorable changes in blood lipids.

Epidemiology of cardiovascular diseases in Warsaw Pol-MONICA area.

In the Warsaw Pol-MONICA area, which is inhabited by 274,000 people of ages 25-64, trends in total mortality showed increases similar to those for the whole of Poland. In Warsaw, mortality from cardiovascular disease in men and from ischaemic heart disease (IHD), myocardial infarction (MI), and cerebrovascular disease in both sexes decreased from 1976 to 1986, whereas trends for these diseases were increasing for the whole of Poland. Within the last 11 years, the MI attack rate and case-fatality rate increased in Warsaw. In the Warsaw male population, an increase in the majority of CHD risk factors was also observed. Age-adjusted mortality rates, MI attack and incidence rates, and stroke attack rates in Warsaw were all higher in men than in women. The mean values of HDL cholesterol and LDL cholesterol, Quetelet's index, and prevalence of hypercholesterolaemia in Warsaw were higher in women than in men, whereas the mean values of triglycerides, diastolic blood pressure, and number of cigarettes smoked as well as prevalence of hypertriglyceridaemia, hypertension, and smoking were higher in men.

Constitutional, biochemical and lifestyle correlates of fibrinogen and factor VII activity in Polish urban and rural populations.

BACKGROUND: Fibrinogen and factor VII activity are known to be related to atherosclerosis and coronary heart disease, but population differences in clotting factors and modifiable characteristics that influence their levels have not been widely explored. METHODS: This paper examines correlates of plasma fibrinogen concentration and factor VII activity in 2443 men and women aged 35-64 in random samples selected from the residents in two districts in urban Warsaw (618 men and 651 women) and from rural Tarnobrzeg Province (556 men and 618 women) screened in 1987-1988, and assesses which characteristics might explain urban-rural differences. Fibrinogen and factor VII activity were determined using coagulation methods. RESULTS: Fibrinogen was 12.9 mg/dl higher in men and 14.1 mg/dl higher in women in Tarnobrzeg compared to Warsaw. Factor VII activity was higher in Warsaw (9.2% in men and 15.3% in women). After adjustment for selected characteristics, fibrinogen was higher in smokers compared to non-smokers by 28 mg/dl in men and 22 mg/dl in women. In women, a 15 mg/dl increase in HDL-cholesterol was associated with a 10 mg/dl decrease in fibrinogen (P < 0.01). After adjustment for other variables, a higher factor VII activity in Warsaw remained significant (a difference of 9.4% in men and 14.8% in women). Lower fibrinogen in Warsaw remained significant only in women (15.4 mg/dl difference). CONCLUSIONS: The study confirmed that sex, age, BMI, smoking and blood lipids are related to clotting factors. However, with the exception of gender differences and smoking, associations between clotting factors and other variables were small and of questionable practical importance.

Management of heart failure patients in Poland.

Over the next 10 years, heart failure is likely to become a medical and sociological problem as a result of improved treatment of ischaemic heart disease and hypertension. At present, in Poland, there are only 50% of the cardiological or cardiac surgery procedures (coronarography, PTCA, CABG, surgery of congenital or acquired heart disease) performed compared to Western Europe. After being registered on the waiting list, it can take anything between 3 and 12 months before the procedure is done. Patients with heart failure have diagnostic tests such as ECG, chest X-ray, and biochemical evaluation performed regardless of the level of care. When echocardiography, exercise testing or Holter monitoring is required, it is done at specialist or reference specialist facilities with a waiting time of approximately 1-3 months. Pharmaceutical treatment of CHF is also inadequate. ACE inhibitors are prescribed in approximately 68% of patients. The average prescribed dosage is far from that recommended in guidelines. Only 18-29% of patients with HF are on beta blockers. The improvement of cardiological care standards depends mainly on the financial resources of State Health System Agencies.

Heart failure in patients seeking medical help at outpatients clinics. Part I. General characteristics.

BACKGROUND: During the last decade, the beneficial changes in lifestyle and in medical care increased average life expectancy, particularly in patients with chronic diseases such as hypertension and coronary heart disease. Unfortunately this also increased the number of patients, particularly among the elderly, who are susceptible to complications of these conditions such as heart failure. Uncontrolled hypertension is known to be a primary cause of heart failure and is also known to be very prevalent and frequently uncontrolled in the Polish population. AIM: To estimate the prevalence and characteristics of heart failure among patients of 65 years and older seeking medical care in outpatient clinics in Poland. METHODS: The study is a cross-country epidemiological project in which 417 physicians from outpatient clinics were asked to register 50 consecutive patients aged 65 years and above seeking medical care for any cause. Information on case history, physical examination (diagnosis of heart failure, NYHA class, heart failure symptoms), laboratory tests (resting ECG, chest X-ray, echocardiogram) and data concerning pharmacology management during the 2 weeks prior to the index visit was obtained. RESULTS: Over 5 months, 19877 eligible patients (7324 men and 12553 women) presented to the 417 participating physicians (90% physicians registered 46-50 patients). Among the patients, 53% were diagnosed with heart failure (3901 men and 6678 women), prevalence did not differ by gender. Among patients with heart failure there were 38% of men in NYHA class III or IV and 34% of women. Coronary heart disease was a predominant cause of heart failure in 87% of men (26% of cases with isolated coronary heart disease, 53% with concomitant hypertension and 8% with other diseases), while percentages for women were 80% (15%, 61% and 4%, respectively). Isolated hypertension was a further cause of heart failure in 8% of men and 13% of women. Cardiac arrhythmia was found in approximately 20% of patients, enlargement of heart size in 32% of patients and peripheral leg edema in 54% of men and 64% of women. These symptoms increased with age. Chest X-ray revealed cardiomegaly in 68% of men and women and increased cardiothoracic ratio (>50%) in approximately 40% of patients. From resting ECGs, cardiac arrhythmia was recorded in 21% of patients with heart failure, with atrial fibrillation as a predominant disorder (19%). Left ventricular hypertrophy on resting ECG was noted in 42% of men and women and old myocardial infarction or cardiac ischemia was diagnosed in 71% of men and 66% of women. CONCLUSIONS: (1) Heart failure was diagnosed in over half of outpatients aged 65 and older; in more than a third of these it was NYHA class III and IV. (2) Outpatients with heart failure had a high frequency of co-existing diseases such as arrhythmia, coronary heart disease and hypertension.

Psychosocial work characteristics and self rated health in four post-communist countries.

STUDY OBJECTIVES: To examine whether psychosocial factors at work are related to self rated health in post-communist countries. DESIGN AND SETTINGS: Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors. MAIN RESULTS: The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. CONCLUSIONS: The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.

Blood pressure levels in the 41 populations of the WHO MONICA Project.

In the early to mid 1980s, the WHO MONICA Project conducted cardiovascular risk factor surveys in 41 study populations in 22 countries. Study populations aged 35-64 years comprised 32,422 men and 32,554 women. Blood pressures (BP) and body mass index (BMI) were measured according to a standard protocol. Participants were asked about antihypertensive medication. In men, the average age-standardized BPs ranged among the populations from 124 to 148 mm Hg for systolic (SBP) and from 75 to 93 mm Hg for diastolic (DBP). The corresponding values in women were 118-145 mm Hg for SBP and 74-90 mm Hg for DBP. In all populations, women had lower SBP than men in the age group 35-44. However, SBP in women rose more steeply with age so that in 34 of 41 populations women had higher SBP than men in the age group 55-64. The proportion of participants with untreated major elevation of BP ranged from 4.5% to 33.7% in men and from 1.9% to 22.3% in women. The proportions of participants receiving antihypertensive medication were 4.3-17.7% for men and 6.0-22.0% for women. These proportions were not correlated with the prevalence of untreated hypertensives. Age-adjusted BMI was associated with SBP and accounted for 14% of the SBP variance in men and 32% in women. We found a large difference in SBP among the MONICA study populations and conclude that the results represent a valid estimate of the public health problem posed by elevated BP. We also have shown that almost universally the problem of elevated BP is more prevalent in women than in men, especially in the older age groups.

Results from a comparative dietary assessment in Europe: I. Comparison of dietary information derived from concurrently applied frequency questionnaires and quantitative measurement instruments.

Data from four central European dietary investigations carried out between 1982 and 1984 in the German Democratic Republic, Poland and the Federal Republic of Germany applying both a food frequency questionnaire (FFQ) and a quantitative recording instrument (24-h recall, 3-d record or 10- to 14-d record) were analysed to compare frequency of food consumption as reported by the FFQ with the corresponding information as derived from the quantitative instrument. The actual intake was found to be overestimated by the FFQ for categories of frequent consumption and underestimated for categories of rare consumption. Categories for which both instruments yielded similar estimates of frequency were found to vary between food items and to depend on the overall frequency of consumption of an item. This indicates that when using unvalidated FFQs and taking their FFQ-categories literally artificial differences of food consumption within the population(s) under study can be introduced. This implies also the tendency that the average food intake estimated through FFQs can yield unrealistically high values for items consumed frequently.

Results from a comparative dietary assessment in Europe: II. Feasibility of pooling individual-based dietary data between countries.

Dietary investigations in four central European survey populations carried out in the German Democratic Republic, Poland and Denmark between 1982 and 1984 using different methodologies were analysed in order to assess the possibilities of characterizing the dietary habits of individual survey participants in a comparable fashion. This was done with the view of assessing the feasibility of a pooled cancer cohort study. For this purpose a method has been devised to combine dietary information derived by food frequency questionnaires and quantitative recording methods into a quantitative characterization of individuals' habits. A comparable characterization between different cultural settings could be demonstrated for a selected list of food items. The selection was determined by the food items considered in common in the different food frequency questionnaires and yielding sufficient and comparable variation as well as absolute amounts of intake. This was more clearly found for food items such as 'fruit' which experience a concise role in dietary habits. However, the observed discrepancies of the different dietary methods within the countries, and, most importantly, between the countries, result in distributions of average daily consumption values which are not deemed to be comparable.

Relationship between IHD risk factors and educational level in the Warsaw Pol-MONICA population.

In the paper presented, the relationship was analysed between the educational level and the level of risk of ischaemic heart disease (IHD) in a random sample of the Warsaw population aged 35-64 years. Men with a lower educational level (elementary or basic vocational) were found to have a significantly higher means for systolic blood pressure level, for plasma high-density lipoprotein (HDL) cholesterol concentration, for the numbers of cigarettes smoked daily, and for the probability of IHD development according to the multivariate logistic function of Farchi and Menotti, and also significantly greater prevalences of cigarette smoking, hypertension and overweight. And for men, a negative relationship was noted between educational level and plasma low-density lipoprotein (LDL) cholesterol concentration. Women with a lower educational level had a higher mean plasma triglyceride concentration, higher values of systolic and systolic blood pressures, a greater probability of IHD development, and higher prevalences of hypertension, obesity and ischaemic heart disease symptoms. And for women, a negative relationship with educational level was noted for plasma LDL-cholesterol concentration and for the mean value of the overall risk score according to Rose.

Comparative data on diet and risk factors from five Eastern European communities.

Starting from large differences in rates and trends of mortality between European countries, an ecological type of comparative study was launched between five population samples in so-called Eastern European countries: Krakow, Warsaw, Novosibirsk, Kaunas, and the German Democratic Republic (GDR). The purpose was to look into dietary data as a possible explanation for varying risk factor and mortality data. It was found that high energy and fat consumption but low carbohydrate intake are common in these populations. The sources of energy and fat however vary markedly. An association was found between diet-related cardiovascular risk factors like the mean total cholesterol value and excess energy or fat intake both in males and in females. It was concluded that changes in diet might be the most important prerequisite for a number of lifestyle changes in these communities, and that those diet changes need to be monitored on a regular basis as part of the national health reports.

[Basic principles of the prevention of cardiovascular diseases in light of knowledge and opinions of the Polish community. III. Possibilities of the use of cardiologic services and their quality in the opinion of the Polish community]. / Podstawowe zasady prewencji chorób ukladu krazenia w swietle wiedzy i opinii spoleczenstwa polskiego. Czesc III Mozliwosc korzystania z opieki kardiologicznej i jej jakosc w swietle opinii spoleczenstwa.

In the mentioned in part 1 and 2 work, there were analyzed possibilities of community using of cardiological care as well as community opinions on principles of cardiovascular prevention. Most of the inquired ones informed that they had mainly used health care in clinics organized at their enterprises or they consult with their general practitioners at regional clinics. 14% of men and 20% of women used specialistic counselling. Within the period of last two years most of the interviewed people had taken medical advices at least several times and women did it more often than men. Among different kinds of laboratory investigations, examination, urine analysis and hematologic examination appeared to be most frequently performed. Arterial blood pressure was measured in about 70% of men and 80% of women and E.C.G. investigation was performed in about 50%. Care of a cardiovascular patient was most often taken by general practitioners or internists. The most commonly mentioned difficulties with using specialistic cardiological care are: drug defficiency, long waiting period for an advice at the clinic and queues at pharmacies. Only 7% of men and 3% of women evaluated specialistic health service care as "fairly satisfactory".

[Basic principles of the prevention of cardiovascular diseases in light of knowledge and opinions of the Polish community. II. Knowledge of coronary disease risk factors]. / Podstawowe zasady prewencji chorób ukladu krazenia w swietle wiedzy i opinii spoleczenstwa polskiego. Czesc II. Znajomosc czynników ryzyka wiencowego.

The study was carried out in 1986, by means of two separated questionnaires, each comprising a 1000-person random sample of the whole Polish population aged above 15 years. The interview showed that 54% of men and 28% of women habitually smoked cigarettes, and 6% of men and 4% of women--occasionally. About 85% of men and 80% of women consumed at least 3 meals per day. Dinner was the most frequently consumed meal. Only 30% of respondents informed that they took food regularly. About 65% of the interviewed people informed that they consumed every day white bread, above 90%--potatoes and vegetables and above a half--meat and meat products. Vegetable oils, margarine and fish appeared to be rarely consumed. About 20% of the inquired ones recognized consumption of dark bread, fish, vegetable oils or margarine as favourable from cardiovascular prevention viewpoint.

[Utilization of risk factors in medical practice for ischemic heart disease evaluation]. / Uzyteczny w praktyce lekarskiej wskaznik ryzyka zachorowania na chorobe niedokrwienna serca.

The Multivariate risk of developing Ischaemic Heart Disease (IHD) during period of 6 years was estimated for men aged 40-59 years on the basis of 2 Polish populations. Coefficients of multivariate logistic function (MLF) were calculated using sample of 4831 men with 240 cases of IHD. The significant risk factors were: age, total serum cholesterol level, diastolic blood pressure, number of cigarettes smoked, familial history of IHD. For these five significant factors new MLF coefficients were calculated. Discriminant power and goodness of fit for both functions were analysed and no significant differences found. The reduced MLF was applied to construct a simple questionnaire of IHD risk test.